Erin Hessey1, Rami Ali2,3, Marc Dorais4, Geneviève Morissette5, Michael Pizzi1, Nikki Rink6, Philippe Jouvet7, Jacques Lacroix7, Véronique Phan8, Michael Zappitelli9. 1. Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, 1001 Blvd Decarie, Room BRC.6168, Montreal, QC, H4A 3J1, Canada. 2. Department of Family Medicine, GMF Centre Medical Hochelaga, Montreal, QC, Canada. 3. Department of Family-Emergency Medicine, Hôpital Général de Hawkesbury and District General Hospital Inc, Hawkesbury, ON, Canada. 4. StatScience Inc, Notre-Dame-de-l'Île-Perrot, QC, Canada. 5. Department of Pediatrics, Pediatric Intensive Care unit, Centre mère-enfant Soleil, Centre Hospitalier de l'Université Laval, Quebec, QC, Canada. 6. Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 7. Department of Pediatrics, Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada. 8. Department of Pediatrics, Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada. 9. Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, 1001 Blvd Decarie, Room BRC.6168, Montreal, QC, H4A 3J1, Canada. mzaprdr@yahoo.ca.
Abstract
BACKGROUND: Baseline serum creatinine (bSCr) is required for diagnosing acute kidney injury (AKI). In children, bSCr is commonly defined as the lowest measurement within 3 months of admission. Measured values are often missing and estimating bSCr using height-based glomerular filtration rate (GFR) equations is problematic when height is unavailable. METHODS: This is a retrospective cohort study including 538 children admitted to the intensive care unit (ICU) between 2003 and 2005 at two centers in Canada, with measured bSCr, height, and ICU-SCr values. We evaluated the bias, accuracy, and precision of back-calculating bSCr from height-dependent and height-independent GFR equations. Agreement of AKI defined using measured and estimated bSCr was calculated. Multivariate analyses were performed to assess the impact of bSCr estimation methods on the association between AKI and ICU mortality, length of stay, and duration of mechanical ventilation. RESULTS: Both methods underestimated bSCr by 1-3%, showed good accuracy (∼30% of patients with estimated bSCr within 10% of measured bSCr), but poor precision (wide 95% limits of agreement). The agreement between AKI defined by estimated versus measured bSCr was >80% (κ >0.5). The height-independent method performed best in children >13 years old; however, overall, both methods performed similarly across age subgroups. AKI was associated with longer stay, prolonged mechanical ventilation, and ICU mortality using measured and estimated bSCr. CONCLUSIONS: Height-dependent and height-independent bSCr estimation methods were comparable. This may have significant implications for performing pediatric AKI research using large databases, and in clinical care to define AKI when height is unknown.
BACKGROUND: Baseline serum creatinine (bSCr) is required for diagnosing acute kidney injury (AKI). In children, bSCr is commonly defined as the lowest measurement within 3 months of admission. Measured values are often missing and estimating bSCr using height-based glomerular filtration rate (GFR) equations is problematic when height is unavailable. METHODS: This is a retrospective cohort study including 538 children admitted to the intensive care unit (ICU) between 2003 and 2005 at two centers in Canada, with measured bSCr, height, and ICU-SCr values. We evaluated the bias, accuracy, and precision of back-calculating bSCr from height-dependent and height-independent GFR equations. Agreement of AKI defined using measured and estimated bSCr was calculated. Multivariate analyses were performed to assess the impact of bSCr estimation methods on the association between AKI and ICU mortality, length of stay, and duration of mechanical ventilation. RESULTS: Both methods underestimated bSCr by 1-3%, showed good accuracy (∼30% of patients with estimated bSCr within 10% of measured bSCr), but poor precision (wide 95% limits of agreement). The agreement between AKI defined by estimated versus measured bSCr was >80% (κ >0.5). The height-independent method performed best in children >13 years old; however, overall, both methods performed similarly across age subgroups. AKI was associated with longer stay, prolonged mechanical ventilation, and ICU mortality using measured and estimated bSCr. CONCLUSIONS: Height-dependent and height-independent bSCr estimation methods were comparable. This may have significant implications for performing pediatric AKI research using large databases, and in clinical care to define AKI when height is unknown.
Entities:
Keywords:
Acute kidney injury; Baseline serum creatinine; Children; Estimation; Glomerular filtration rate; Pediatric intensive care unit
Authors: Leila C Volpon; Edward K Sugo; Julio C Consulin; Tabata L G Tavares; Davi C Aragon; Ana P C P Carlotti Journal: Pediatr Crit Care Med Date: 2016-05 Impact factor: 3.624
Authors: David T Selewski; Timothy T Cornell; Michael Heung; Jonathan P Troost; Brett J Ehrmann; Rebecca M Lombel; Neal B Blatt; Kera Luckritz; Sue Hieber; Robert Gajarski; David B Kershaw; Thomas P Shanley; Debbie S Gipson Journal: Intensive Care Med Date: 2014-07-31 Impact factor: 17.440
Authors: Omar Alkandari; K Allen Eddington; Ayaz Hyder; France Gauvin; Thierry Ducruet; Ronald Gottesman; Véronique Phan; Michael Zappitelli Journal: Crit Care Date: 2011-06-10 Impact factor: 9.097
Authors: Erin Hessey; Geneviève Morissette; Jacques Lacroix; Sylvie Perreault; Susan Samuel; Marc Dorais; Véronique Phan; Philippe Jouvet; Jean-Philippe Lafrance; Jacques LeLorier; Ana Palijan; Michael Pizzi; Louise Roy; Michael Zappitelli Journal: Clin J Am Soc Nephrol Date: 2018-04-20 Impact factor: 8.237
Authors: Erin Hessey; Alex Paun; Kelly Benisty; Kelly McMahon; Ana Palijan; Michael Pizzi; Catherine Morgan; Michael Zappitelli Journal: Pediatr Nephrol Date: 2022-01-17 Impact factor: 3.651
Authors: Chloe Braun; A K M Fazlur Rahman; Eric Macomb; David Askenazi; Erica C Bjornstad Journal: Pediatr Nephrol Date: 2022-05-04 Impact factor: 3.651
Authors: Erica C Bjornstad; Kelli A Krallman; David Askenazi; Michael Zappitelli; Stuart L Goldstein; Rajit K Basu Journal: Clin J Am Soc Nephrol Date: 2020-11-03 Impact factor: 8.237
Authors: Takuma Iwaki; Brock G Bennion; Erin K Stenson; Jared C Lynn; Cynthia Otinga; Danijel Djukovic; Daniel Raftery; Lin Fei; Hector R Wong; W Conrad Liles; Stephen W Standage Journal: Physiol Rep Date: 2019-05
Authors: David D'Arienzo; Erin Hessey; Rami Ali; Sylvie Perreault; Susan Samuel; Louise Roy; Jacques Lacroix; Philippe Jouvet; Genevieve Morissette; Marc Dorais; Jean-Philippe Lafrance; Veronique Phan; Michael Pizzi; Rahul Chanchlani; Michael Zappitelli Journal: Can J Kidney Health Dis Date: 2019-02-10